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Social influences on trajectories of self-rated health: evidence from Britain, Germany, Denmark and the USA
  1. Amanda Sacker1,
  2. Diana Worts2,
  3. Peggy McDonough2
  1. 1Institute for Social and Economic Research (ISER), University of Essex, Wivenhoe Park, Colchester, UK
  2. 2Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada
  1. Correspondence to Professor Amanda Sacker, Institute for Social and Economic Research (ISER), University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK; asacker{at}


Background This study investigates social inequalities in self-rated health dynamics for working-aged adults in four nations, representing distinct welfare regime types. The aims are to describe average national trajectories of self-rated health over a 7-year period, identify social determinants of cross-sectional and longitudinal health and compare cross-national patterns.

Methods Data are from national household panel surveys in Britain, Germany, Denmark and the USA. The self-rated health of working-age respondents is measured for the years 1995–2001. Social indicators include education, occupational class, employment status, income, age, gender, minority status and marital status. Latent growth curve models are used to estimate both individual change and average national trajectories of self-rated health, conditioned on the social indicators.

Results Ageing-vector graphs reveal general declines in health as people age. They also show differential patterns of change for specific national cohorts. Older cohorts in Denmark had poorer health and young cohorts in the USA had better health in 2001 than 1995. Social covariates predicted baseline health in all four countries, in ways that were consistent with welfare regime theories. Once inequalities in baseline health were accounted for, the few determinants of mean health decline occurred mainly in the USA, again in line with theoretical expectations. Finally, trajectories of health for those in average and advantaged social circumstances were similar, but disadvantaged individuals had much poorer health trajectories than ‘average’ individuals. The differences were greatest in the countries with lower levels of public transfers.

Conclusion National differences in self-rated health trajectories and their social correlates may be attributed partly to welfare policies.

  • ageing
  • comparative study
  • longitudinal data analysis
  • self-rated health
  • socioeconomic factors
  • social differences
  • social welfare

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  • Funding The research for this paper was supported by funding from the Social Sciences and Humanities Research Council of Canada (grant 410-07-0913) and the UK Economic and Social Research Council (grant RES-596-28-0001).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.